In the early years of South Africa’s democracy, as the country confronted one of the most devastating public health emergencies in its history, the government turned to an unconventional yet powerful solution: mobilising ordinary citizens to save lives. Community Health Workers (CHWs), also known as Lay Counsellors, were introduced under the leadership of former Health Minister Manto Tshabalala-Msimang during the height of the HIV and AIDS crisis. At a time when infection rates were soaring and the healthcare system was overwhelmed, these workers became the frontline of a community-based response that would change the trajectory of the epidemic.
Many CHWs were themselves living with HIV. In an era marked by stigma, fear and misinformation, they displayed extraordinary courage by publicly disclosing their status, sharing their experiences and encouraging others to test and adhere to treatment. Their lived experience built trust that formal institutions often struggled to achieve. They entered homes where doctors could not reach, comforted families facing loss and helped communities move from denial to acceptance. In doing so, they did more than deliver services — they restored hope and dignity.
Over time, CHWs evolved into a cornerstone of primary healthcare, particularly in rural and underserved communities – the COVID-19 pandemic also gave great credence to this particularism. They provide health education, home-based care, maternal and child health support, disease monitoring and linkage to clinics. They are often the first point of contact for vulnerable households and serve as a critical bridge between communities and the formal health system. Despite this indispensable role, they have historically been compensated through modest stipends — starting at around R500 per month and only gradually rising to approximately R5 288 today, still far below a living wage. Their service has been characterised by sacrifice rather than security.
It is against this backdrop that the recent decision to appoint CHWs permanently — a step long demanded by workers and advocates — should have been a moment of celebration. Permanent employment would recognise decades of service and provide long-overdue stability. However, the introduction of a Matric qualification as a minimum requirement risks turning this victory into a profound injustice. When the programme was established, formal schooling was never a condition for recruitment. Selection was based on community trust, commitment, lived experience and willingness to undergo training. Many of those who stepped forward did so precisely because the programme recognised the value of community knowledge over formal credentials.
The new requirement excludes a significant number of long-serving CHWs who sustained the programme through its most difficult years. Ironically, it favours individuals with shorter service histories while sidelining those who built the foundation of community healthcare delivery. Such a shift not only disregards institutional memory and experience but also exposes veteran workers — many of whom sacrificed educational opportunities due to poverty and apartheid-era inequalities — to renewed economic vulnerability.
This policy must therefore be interrogated not only as an administrative decision but as a moral question. Can a nation that relied on these workers in its darkest hour now discard them because they lack formal qualifications they were never required to have? Fairness demands that experience, years of service and proven competence be recognised as valid forms of expertise. Transitional arrangements, recognition of prior learning or bridging programmes could achieve professionalisation without exclusion.
Moreover, the Constitution of South Africa and the Employment Equity Act prohibit unfair discrimination in employment policies and practices. A requirement that disproportionately excludes long-serving workers from disadvantaged backgrounds risks violating both the spirit and the letter of these protections. Policies intended to uplift workers should not become instruments of exclusion.
South Africa’s CHWs did not ask for comfortable conditions, recognition, or wealth when they stepped forward to serve. They answered to a national call of action, often at great personal cost. Today, the country faces a different test — whether it will honour that sacrifice or allow bureaucratic requirements to erase it.
A humane and just resolution is still possible. Government, labour unions and civil society must engage constructively to ensure that professionalisation strengthens rather than fractures the programme. The goal should be inclusion, fairness and sustainability — not the replacement of experienced workers with technically qualified but less seasoned counterparts.
If South Africa truly values the principles of dignity, equality and social justice on which its democracy was founded, then it must ensure that the very people who carried communities through crises are not left behind in the pursuit of reform. The measure of progress is not how efficiently systems are redesigned but how faithfully a nation protects those who served it when it mattered most.
Thembisa Witbooi is a trade unionist in the Public Service and Life Long Fellow at the Atlantic for Health Equity in South Africa with TEKANO
In the early years of South Africa’s democracy, as the country confronted one of the most devastating public health emergencies in its history, the government turned to an unconventional yet powerful solution: mobilising ordinary citizens to save lives. Community Health Workers (CHWs), also known as Lay Counsellors, were introduced under the leadership of former Health